Health Data Management recently published a list of healthcare IT experts on Twitter that health IT executives should follow on Twitter. Here’s the summary Fred Bazzoli offered for the list:

Social media has transformed the ability of those with expertise to share their views on recent events with a larger audience. Nowhere is this more true than on Twitter, which attracts millions of visits per day. Healthcare technology and IT experts are among those who frequently offer their slant on the news of the day.

A big thank you to Health Data Management for the recognition. We’re proud to be listed in such great company. We’ll continue to work hard in our effort to continually provide value to healthcare IT executives.

WESTBOROUGH, Mass.—December 6, 2016— At eClinicalWorks, we are deeply committed to ensuring the safety of all patients whose health care providers rely on our software. For this reason, we have made a sustained effort to continuously improve our system and processes and to educate users on the proper use of our software to ensure patient safety. Even with these efforts, given our large base of users and the complexity inherent to all EHR systems, we periodically identify potential patient safety risks related to the use of our software. As part of our ongoing effort to respond to and minimize such risks, eCW is making this announcement to ensure that all participants in the healthcare process – clinicians, pharmacies, and patients and their family members or caregivers – are aware of key patient safety risks and are focused on the roles they can play in minimizing those risks.

Ensuring the safety of patients requires collaboration and communication between individuals, their physicians, others involved in healthcare delivery, and EHR companies. With this in mind, we are issuing the following reminders:

The use of eCW’s EHR software carries with it risks related to medication management, electronic prescribing, and the ordering process for tests and procedures, which are among the most complex functions performed by any EHR system.

In December 2015, for instance, in response to certain identified concerns, eCW advised users to install all software upgrades and patches and make adequate network resources available to allow the system to operate properly. Prior to and since that time, eCW has issued other similar patient safety-related notices, all of which are available to eCW users at my.eclinicalworks.com.

Consistent with our prior advisories, clinicians should continue to be vigilant about medication management, e-prescribing and the ordering of tests and procedures. Specifically, clinicians should review and adopt the measures outlined in both eCW’s December 2015 advisory and the other patient safety-related notices issued by eCW. These measures include the following:

Upgrade to the most current version of eCW’s software: In July 2016, the company directed all users to upgrade to the latest version of V10-SP1-C20.8 or higher to ensure that all changes designed to improve patient safety are implemented. If you have not already done so, you should immediately install version V10-SP1-8 or higher, as well as all update patches. Failure to continually install updates may result in the software not receiving all necessary corrective fixes.

Upgrade to the most current version of the Multum or Medispan drug databases:eCW releases regular updates to commercial drug database information to ensure that the most current medication information is used. For cloud customers, this information is updated automatically; for non-cloud customers, the content update should be downloaded regularly.

Designate a patient safety officer: As our previous advisories have made clear, every physician office should designate a patient safety officer to serve as the primary liaison with eCW on patient safety-related matters.

Read every patient safety notice: Patient safety advisories and similar notices are an important way in which eCW communicates about potential risks to patient safety related to the use of our software. These notices explain the potential risk and recommend actions to mitigate the risk. Providers should carefully read every patient safety notice, alert, or advisory that we issue and implement the recommended actions to ensure patient safety. Again, eCW users can view a complete collection of these notices at my.elinicalworks.com.

Confirm order accuracy: To avoid errors, providers should always confirm that prescriptions and orders created using eCW’s software are accurate.

Encourage patients to confirm accuracy: You should ensure that your patients and their family members or caregivers are informed about medications, dosages, and other pertinent information about prescriptions and orders. Among other things, this should include encouraging them to obtain online patient portal accounts. Additionally, you should instruct them to confirm that the correct medication has been dispensed by their pharmacists and that other types of orders have also been properly fulfilled.

Follow correct steps for modifying medications: Rather than modifying an existing medication by changing the dosage or route, clinicians should discontinue the original medication and reorder it with the revised dosage or route.

Exercise caution in the use of custom medications: Because the use of custom medications poses a higher risk of prescription errors, providers should limit their use whenever possible. When custom medications are necessary, care should be taken to ensure that the prescriptions are properly transmitted and fulfilled.

Patients and their family members or caregivers should adopt the following safeguards:

Be educated about your care: Ask your physician to give you or your caregiver access to eCW’s online patient portal, where you can review your visit summaries, medication orders and tests.

Know your medications and orders: Be aware of the prescription medications (including names, dosages, and delivery methods) and the clinical, diagnostic, or other evaluative tests that have been ordered by your physician.

Be sure to confirm accuracy: Confirm that the correct medication has been dispensed by your pharmacist and that tests are performed as ordered.

Anyone – clinicians, prescribers, pharmacists, patients, caregivers, or others – who becomes aware of patient safety concerns or unexpected software issues should immediately report them to eCW at my.eclinicalworks.com and/or to the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology’s complaint website at www.healthit.gov/healthitcomplaints.

It’s been fascinating to watch the number of health sensors blow up over the years. The sad part of the last 3-5 years has been that a huge majority of the sensors that were hitting the market were essentially me too products. How many fitness trackers, blood pressure cuffs, smart scales, heart rate monitors, etc do we need. No doubt each of these products has produced some successful businesses, but have they really moved the needle on healthcare? My answer is no and that’s because these health sensors aren’t very clinically relevant.

The good thing is that I’ve started to see a wider variety of sensors that measure everything imaginable on your body. None of these have been breakout hits yet, but that’s largely because they’re trying to really measure something that’s clinically relevant versus creating a consumer toy.

There are a lot of ways to look at the health sensor market, but one way is to look at which part of the body they’re using to measure some health indicator. Here’s a list of some of the sensors I’ve seen over the past couple years (starting with the obvious ones):

Skin

Motion

Sweat

Blood

Eye

Visual

Brainwaves

Stool

Blood Flow

Spit

As you can see, there are companies working on measuring every output we produce in order to try and understand our health. Some of these we’ve been doing forever like blood tests. Labs are such an important part of healthcare. However, what’s different about the latest generation of health sensors is that most of these health sensors are going direct to consumers as opposed to selling to the healthcare providers.

Think about that shift. That’s a massive change. Plus, the ironic part is that many healthcare providers are adopting and using consumer sensors in their healthcare organizations. I’m also interested in how this shift in information is going to change the balance of power in healthcare. Information is power.

Are there other sensors out there that you see coming to market? Which ones do you think will be most clinically relevant?

In the midst of a merger with a major Pennsylvania healthcare organization, Tim Schoener is wholly focused on EHR transition. He outlines Susquennaha’s plan for each aspect of transition, offering innovative and unique approaches to each. In addition, Schoener provides cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. This interview touches on many of the considerations necessary for a successful EHR transition as Schoener discusses minimizing surprises during a transition; why migrating a year’s worth of results is optimal; and how their document management system fulfills archival needs.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Looking for additional EMR replacement perspectives & lessons learned? View a recent panel where HCO leaders discussed their experiences with EHR transition, data migration & archival.

KEY INSIGHTS

Absolutely, we have problem lists that can’t be reconciled; there’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all.

We’re being told, if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.

Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

Let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move.

It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare.

CHIME is a great way to challenge yourself as a CIO and in your leadership. It pushes me in my leadership skills and helps to focus me back to what’s critical in the industry.Campbell: Tell me a little about yourself and your organization’s initiatives

Schoener: I’m Tim Schoener, the VP/CIO of, originally Susquehanna Health, which, as of October 1st, is now a part of the University of Pittsburgh Medical Center (UPMC) and re-named to UPMC Susquehanna. We’re located in central Pennsylvania, four hours away from Pittsburgh.

A major IT initiative for us is that we’re swapping out our EMR over the next couple of years. We are currently a Cerner Soarian customer. In fact, we were the initial Soarian beta site for Financials and second for Clinicals. We determined we eventually need to migrate to something else – that’s an Epic or Cerner decision for us at this point. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. As of this writing, we’ve made the decision to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned on the journey that we’re about to take and by late next year we will likely be starting an implementation.

We currently leverage NextGen on the Ambulatory side, with approximately 300 providers that use that software product. We’re a four hospital system: two of which are critical access, one which is predominately outpatient, and the other a predominately inpatient facility. We were about a $600MM organization prior to our UPMC acquisition.

Campbell: Related to your current implementation, tell me a little bit about your data governance strategy and dictionary mapping that may occur between NextGen and Soarian.

Schoener: We definitely have a lot of interfaces, a lot of integration between the two core systems. From an integration perspective, we have context sharing, so physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We do pass some data back and forth—allergies and meds can be shared through a reconciliation process—but we certainly aren’t integrated. It’s the state of healthcare.

Campbell: That’s why you anticipate moving to a single platform, single database?

Schoener: Absolutely, we have problem lists that are not reconciled. There’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all. Meds and allergies are pretty much all we get in terms of outpatient to inpatient clinical data sharing today.

Campbell: Do you leverage an archival solution for any legacy data?

Schoener: We use EMC and have large data storage with them. I wouldn’t call it archival, but we have an electronic document management system – Soarian’s eHIM.

There’s a huge amount of data out there and I know you have some questions related to our thinking with respect to migration. I have some thoughts around that related to levering our document management system versus archiving into a separate system. I’m pretty certain we would be thinking ‘why not use eHIM as our archival process, and just put other data in that repository as necessary?’ For results data, for instance, what we’re thinking of migrating, or what our providers are requesting, is a years’ worth of results. ‘Give me a year’s worth of results, and then make sure everything else is available in eHIM.’

Campbell: As such, your default is to migrate a year’s worth of data?

Schoener: Yes. We would presume that the provider is probably not going to refer back to lab results or radiology results beyond a year, other than for health maintenance kind of things such as mammograms, pap smears, PSAs; those types of things.

Campbell: What expectations have you set with physicians when they go live on the new EMR?

Schoener: From an ambulatory perspective, we’re thinking that it would be nice to have the most recent note from the EMR available. All of the other notes for that patient would be consolidated into one note via a single pdf attachment. The note that’s the separate most recent note, we envision that being in a folder for that particular date. That note would reside in the appropriate folder location just like it would in the current EMR. Our goal is to bring the clinical data forward to the new EMR, taking all the other notes and placing them in a “previous notes” folder.

Campbell: Can you elaborate on your consideration of PAMI (Problems, Allergies, Medications, Immunizations) as part of the data migration?

Schoener: Sure. The disaster scenario would be the physician sits down with patient for first time with new EMR, and there are no meds, no allergies, and no problems! They’ll spend 25 minutes just gathering information, that would not work.

We’re thinking of deploying a group of nurses to assist with the data conversion and migration process. Our intent is to have them to retrieve CCDAs to populate those things I mentioned by consuming them right into the medical record, based on the physicians’ input. We expect there to be a reconciliation process to clean-up potential duplicates. Or, to be candid, we’ve talked about automating the CCDA process, consuming discrete clinical items from it by writing scripts and importing into the new EMR. I think we’re leaning towards having some staff involved in the process though.

Now if you share the same database between your acute and ambulatory EMR, and the patient was in ambulatory setting but now they’ve been admitted, it’s the same database: the meds are there, the problems are there, the allergies are there; it’s beautiful, right? If they weren’t, then the admission nurse is going to have to follow the same CCDA consume process that the ambulatory nurse followed. Or you start from scratch. On the acute side, we start from scratch a lot. Patients come in and we basically just start asking questions in the ER or in an acute care setting. We start asking for their meds, allergies, or problems – whatever they may have available.

Campbell: We’ve discussed notes, results and PAMI. Are there other clinical data elements that you’ve examined? How will you handle those?

Schoener: From an acute care perspective, our physicians are very interested in seeing the last H & P (History & Physical Examination) and the last operative note, so we’re going to consider two different ideas. One would be that all of that data would still reside in document management, which has the ability to be sorted. It’s currently very chart centric. For instance, you can easily pull the patient’s last acute care stay. There is the ability, however, to sort by H & P, operative note, or discharge summary—something along those lines for the separate buckets of information. Therefore, a physician could view the most recent H & P or view all sorted chronologically. In addition, they’ll be able to seamlessly launch directly from the new EMR to the old EMR, bypassing authentication, which is important to mitigate context switching.

One of the areas we’re struggling with is the growth chart. A physician would love the ability to see a child’s information from start to finish, not just from the time of the EMR transition. So that means some sort of birth height/weight data that we would want to retrieve and import into the new system so a growth chart could be generated. The other option is to somehow generate some sort of PDF of a growth chart up until the place where we transitioned to the new EMR. The latter however, would result in multiple growth charts, and a physician’s not going to be happy with that. So we’re trying to figure that one out.

Another area of concern is blood pressure data. We’re struggling with what to do with a patient we’re monitoring for blood pressure. We’d like to see more than one blood pressure reading and have some history on that.

Campbell: Thank you for elaborating on those items. What about data that is not migrated. How will that be addressed and persisted going forward?

Schoener: For the most part, everything else would be available in the document management system. We can generate that data from document our document management system and make it available to be queried by OIG or whoever else requires that data from a quality perspective. We are aware that an archival solution is very expensive. We’re being told, ‘if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.’ If that’s what the advisors and consultants are saying, then our thought is that probably isn’t going to be the direction we’re going to go. We’re likely going to stick with some type of document management system for archival.

Campbell: Very good. How are you gathering feedback from different specialties and departments? Do you have a governance process in place?

Schoener: So as you may have gathered, we’re getting ready. I don’t want surprises. I want physicians to be prepared and to set expectations for what’s going to be available. What I just described to you, we’ve vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

There will definitely be a learning curve with the new EMR, but we want to be clear and set expectations with respect to data migration and conversion, so that when the physician does use the new EMR they’re not saying ‘that darn Cerner or Epic.’ It’s more ‘that’s a part of the data migration process and we weren’t able to accomplish that.’

Campbell: What about legacy applications support. Will all of your staff be dedicated to the new project?

Schoener: I mean, let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move. We still haven’t decided what to do.

Campbell: I agree that no staff member wants to be left behind. I’ve talked to organizations where they use folks for both and it just doesn’t end well. You can’t expect them to do both, learning the new system while supporting the old one.

Schoener: I guess it depends on the capacity and the expectation of that particular project they’re working on. Maybe there is a person who has less involvement with the new EMR and they have availability where they can support both, although it’s unlikely. Sometimes you end up having someone who wants to retire within the time period. In that case, they can almost work their way to retirement and then not ever support the new EMR, although that situation is also unlikely.

It’s a great question, and one we’re going to have to have folks help us determine.

Campbell: Shifting gears a little bit, what are your thoughts on health data retention requirements? Too loose? Too stringent? As you know, it varies state-to-state, from 7-10 years, but I feel like there’s a huge responsibility that is placed on organizations to be the custodians of that data. Do you agree?

Schoener: I think that’s just healthcare. A lot of it is legal considerations and our need to protect ourselves. That’s why do we do a lot of the things we do. We’re protecting ourselves from lawsuits and litigation. I think it’s expected; it’s just the nature of the business. Just think of what we had in a paper world. We used to have rooms and rooms full of charts and now that’s all gone. With our current process, any paper that comes in is scanned in within the first 24 hours. So it’s not something I worry about. My focus now is making sure our providers can perform excellent patient care on the new EMR.

Schoener: Get ready for some fun! Affiliations and acquisitions are greatly impacting these decisions. It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare. One bit of wisdom for anyone is: if you’re not interested in that type of transition and change occurring, healthcare’s not for you. That’s the nature of the business we’re in.

I would say from an EHR transition process, I found that having an advisor is extremely beneficial to help me think outside of my day-to-day operations. They’re able to look outside of your organization and ask the right questions. If you pick the right advisor, they’ll protect you and protect your organization. I think it’s been very healthy for us to have someone from the outside give us counsel and advice because it’s a tough process. It’s extremely expensive, and extremely polarizing.

Campbell: Outside of the networking, what did you come to CHIME focused on this year?

Schoener: CHIME is a great way to challenge yourself as a CIO and in your leadership, it pushes me in my leadership skills and helps to focus me back to what’s critical in the industry. It helps me to think more strategic and broad, not to get too engaged in one particular topic. I think it’s just great for professional development. CHIMEs the best out there with respect to what I do.

About Tim SchoenerTim Schoener is the Vice President/Chief Information Officer for UPMC Susquehanna, a new partner of UPMC since October 1, 2016, which is a four-hospital integrated health system in northcentral Pennsylvania including Divine Providence Hospital, Muncy Valley Hospital, Soldiers + Sailors Memorial Hospital and Williamsport Regional Medical Center. UPMC Susquehanna has been Most Wired for 14 of the last 16 years and also HIMSS Level 6. Tim has worked at Susquehanna for over 24 years, 19 of those years in Information Technology. He also has responsibilities for health records, management engineering and biomedical engineering. He is a CHCIO, HIMSS Fellow and CPHIMS certified. Tim received his undergraduate degree from The Pennsylvania State University with a BSIE in Industrial Engineering and his MBA from Liberty University.

About Justin CampbellJustin is Vice President, Strategy,atGalen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at@TJustinCampbellandLinkedIn.

About Galen Healthcare SolutionsGalen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of theTackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us onTwitter,FacebookandLinkedIn.

Vaco, Pivot Point Consulting and Greythorn join to form new healthcare IT powerhouse

NASHVILLE, TN, Dec. 7, 2016 – National consulting and talent solutions firm, Vaco, today announced the formation of Pivot Point Consulting, a Vaco Company. Vaco’s healthcare IT division, Vaco Healthcare, acquired Pivot Point Consulting based in Seattle and Greythorn based in Bellevue, WA to offer expertise in EHR implementation, training, optimization, legacy and go-live support, project management and strategic advisory services. The new HIT services firm brings together more than 50 employees and 250 consultants across the nation.

“Expanding our team to include Pivot Point and Greythorn enhances Vaco’s extensive healthcare network and nationwide scale with award-winning expertise and accreditation,” Vaco Healthcare Managing Partner Matt Simpson said. “We are excited to offer our clients even more in the way of consulting, contract and direct-hire solutions.” The newly combined organization will:

Service the full scope of EHR implementation from pre-selection to support, project management, training, go-live, optimization and legacy support.

Offer a LIVESite division that provides top tier credentialed trainers and go-live support consultants along with advisors on best practices, gap analysis and key expense management savings.

Pivot Point Consulting is a healthcare IT consulting firm that provides implementation, staff augmentation and advisory services for healthcare provider organizations. In 2016, Pivot Point ranked number 1 in KLAS for Epic Consulting in the Select Category and number nine in Modern Healthcare’s Best Places to Work. They are leaders in EHR consulting services, strategic planning, project management, PMO, legacy and go-live support. With employees in 30 states, the company has provided services to over 40 healthcare organizations, including large multi-hospital networks, academic institutions, pediatric hospitals and local community clinics.

“This new venture broadens our global reach and complements our extensive menu of services,” said Rachel Marano, Managing Partner and Co-Founder of Pivot Point Consulting. “Combining the talents of these three businesses strengthens the options for our current and prospective clients.”

Greythorn specializes in placing top industry talent in healthcare IT on a project and permanent basis. Like Pivot Point, Greythorn has a significant focus in providing resources with Epic EHR expertise. Through their LIVESite delivery system, Greythorn provides Epic training experts, hands-on training leadership support, strategy and planning, project management, and staff engagement and retention solutions. The company also offers a dynamic Open Source/Big Data direct-hire staffing team that continues expansion within that community.

“The cultures of our three businesses match extremely well,” said Ben Weber, Managing Partner of Greythorn. “Greythorn has produced results here in the U.S. for over 16 years. We look forward to building on our success as part of this new company.”

Pivot Point Consulting, a Vaco Company begins offering services to healthcare provider organizations as an integrated business on Jan. 2, 2017.

About Vaco

Vaco offers consulting, contract and direct-hire solutions in the areas of accounting, finance, technology, healthcare, operations and general administration. With more than 30 offices across the nation and beyond, Vaco has been on Inc. magazine’s list of the nation’s fastest-growing private companies for the last 10 years. Vaco is dedicated to developing creative client solutions, long-term relationships and lifelong careers. For more information, visit vaco.com.

About Pivot Point

Established in 2011, Pivot Point Consulting is a healthcare IT consulting leader providing implementation, optimization, project management, legacy support and strategic advisory services nationwide. The company has earned many industry and workplace quality awards including: #1 in KLAS for Epic Consulting in the Select Category in 2016, #3 for HIT Implementation Support and Staffing in the 2015/2016 Best in KLAS: Software & Services report, #9 in Modern Healthcare’s Best Places to Work in 2016, #4 Fastest Growing Company by Consulting Magazine in 2015, Consulting Magazine’s Seven Small Jewels Award, Puget Sound Business Journal’s #1 Fastest Growing Eastside Seattle Firm, Puget Sound Business Journal’s #3 Fastest Growing Firm in Washington, Rising Star of the Profession by Consulting Magazine and Crain’s 101 Best and Brightest Companies to Work For in 2014 & 2015. For more information about Pivot Point Consulting, visit www.pivotpointconsulting.com.

About Greythorn

Greythorn is a specialist technology and healthcare IT recruitment consultancy, placing highly skilled talent across the United States and Canada in full-time and contract roles.

Through a boutique approach and specialist expertise that focuses on specific industries and technologies, Greythorn partners with like-minded businesses that are looking for true value from a recruitment partner. For more information, visit greythorn.com.

The following is a guest blog post by Abhinav Shashank, CEO & Co-founder of Innovaccer.
Former US President Abraham Lincoln once said, “Give me six hours to chop down a tree and I’ll spend four hours sharpening the ax.” After having a look at the efficiency of the US healthcare system, one cannot help but notice the irony. A country spending $10,345 per person on healthcare shouldn’t be on the last spot of OECD rankings for life expectancy at birth!

Increasing Troubles
A report from Commonwealth Fund points out how massive the US health care budget is. Various US governments have left no stone unturned in becoming the highest spender on healthcare, but have equally managed to see most of its money going down the drain!

The US is 3rd when it comes to public spending on health care. The figure is $4197 per capita, but it covers only 34% of its residents. On the other hand, the UK spends only $2,802 per capita and covers 100% of the population!

With $1,074, US has the 2nd highest private spending on healthcare.

In 2013, US allotted 17.1% of its GDP to healthcare, which was the highest of any OECD country. In terms of money, this was almost 50% more than the country in the 2nd spot.

In the year 2013, the number of practicing physicians in the US was 2.6 per 1000 persons, which is less than the OECD median (3.2).

The infant mortality rate in the US was also higher than other OECD nations.

68 percent of the population above 65 in the US is suffering from two or more chronic conditions, which is again the highest among OECD nations.

The major cause of these problems is the lack of knowledge about the population trends. The strategies in place will vibrantly work with the law only if they are designed according to the needs of the people.

What is Population Health Management?
Population health management (PHM) might have been mentioned in ACA (2010), but the meaning of it is lost on many. I feel, the definition of population health, given by Richard J. Gilfillan, President and CEO of Trinity Health, is the most suitable one.

“Population health refers to addressing the health status of a defined population. A population can be defined in many different ways, including demographics, clinical diagnoses, geographic location, etc. Population health management is a clinical discipline that develops, implements and continually refines operational activities that improve the measures of health status for defined populations.”

The true realization of Population Health Management (PHM) is to design a care delivery model which provides quality coordinated care in an efficient manner. Efforts in the right direction are being made, but the tools required for it are much more advanced and most providers lack the resources to own them.

Countless Possibilities
If Population Health Management is in place, technology can be leveraged to find out proactive solutions to acute episodes. Based on past episodes and outcomes, a better decision could be made.

The concept of health coaches and care managers can actually be implemented. When a patient is being discharged, care managers can confirm the compliance with health care plans. They can mitigate the possibility of readmission by keeping up with the needs and appointments of patients. Patients could be reminded about their medications. The linked health coaches could be intimated to further reduce the possibility of readmission.

Let us consider Diabetes for instance. Many times Diabetes is hereditary and preventive measures like patient engagement would play an important role in mitigating risks. Remote Glucometers, could be useful in keeping a check on patient sugar levels at home. It could also send an alert to health coaches and at-risk population could be engaged in near real-time.

Population Health Management not only keeps track of population trends but also reduces the cost of quality care. The timely engagement of at-risk population reduces the possibility of extra expenditure in the future. It also reduces the readmission rates. The whole point of population health management is to be able to offer cost effective quality-care.

The best thing to do with the past is to learn from it. If providers implement in the way Population Health Management is meant to be, then the healthcare system would be far better and patient-centric.

Success Story
A Virginia based collaborative started a health information based project in mid-2010. Since then, 11 practices have been successful in earning recognition from NCQA (National Committee for Quality Assurance). The implemented technologies have had a profound impact on organization’s performance.

For the medical home patients, the 30-day readmission rate is below 2%.

The patient engagement scores are at 97th percentile.

With the help of the patient outreach program almost 40,000 patients have been visited as a part of preventive measures.

All this has increased the revenue by $7 million.

Barriers in the journey of Population Health Management
Currently, population health management faces a lot of challenges. The internal management and leadership quality has to be top notch so that interests remain aligned. Afterall, Population Health Management is all about team effort.

The current reimbursement model is also a concern. It has been brought forward from the 50s and now it is obsolete. Fee-for-service is anything, but cost-effective.

Patient-centric care is the heart of Population Health Management. The transition to this brings us to the biggest challenge and opportunity. Data! There is a lot of unstructured Data. True HIE can be achieved only if data are made available in a proper format. A format which doesn’t require tiring efforts from providers to get patient information. Providers should be able to gain access to health data in seconds.

The Road Ahead
We believe, the basic requirement for Population Health Management is the patient data. Everything related to a patient, such as, the outcome reports, the conditions in which the patient was born, lives, works, age and others is golden. To accurately determine the cost, activity-based costing could come in handy.

Today, the EMRs aren’t capable enough to address population health. The most basic model of population health management demands engagement on a ‘per member basis’ which can track and inform the cost of care at any point. The EMRs haven’t been designed in such a way. They just focus on the fee-for-service model.

In recent years, there has been an increased focus on population health management. Advances in the software field have been prominent and they account for the lion’s share of the expenditure on population health. I think, this could be credited to Affordable Care Act of 2010, which mandated the use of population health management solutions.

Today, the Population Health Management market is worth $14 billion and according to a report by Tractica, in five years, this value will be $31.8 billion. This is a good sign because it shows that the focus is on value-based care. There is no doubt we have miles to go, but at least now we are on the right path!

Engagement with Clients and Members Continues to Boost Telehealth Utilization

LEWISVILLE, Texas (December 6, 2016) –Teladoc, Inc. (NYSE: TDOC), the undisputed leader in telehealth, providing access to care for millions, announced today that a company record was set during the month of November with a total of 101,600 patient visits. The impressive milestone was fueled by an increase in utilization among existing members, along with new members and expanded clinical services. The American Telemedicine Association (ATA) predicted the telehealth industry to record a total of 1.25 million visits in 2016, and Teladoc is accounting for significant growth in the market as demonstrated by its new record monthly visit volume.

“This new milestone of more than 100,000 monthly patient visits further substantiates that Teladoc has the scalable platform, clinical expertise and member support needed to effectively manage the increased volume as more and more consumers are engaging with us,” said Stephany Verstraete, chief marketing officer, Teladoc. “Our innovative approach to driving adoption is proving effective in shifting member mindset; members are embracing Teladoc as a valued care option.”

Further substantiating the significance of the Teladoc milestone is that the CDC has reported total flu visits to be below the national baseline this year. Rather, it is the Teladoc member engagement initiatives, broad network of U.S. board-certified physicians, and expansion into clinical specialties that are credited with fueling Teladoc’s growth in patient visits. In addition to the record high of monthly visits, Teladoc also set a daily visit record high during November of 4,158 visits, along with the busiest hour which saw 425 visits, or one visit every 8.5 seconds.

“Our superior member engagement practices combined with the strength and breadth of our offerings are enabling us to meet consumers where they are, provide the quality services they need, and deliver industry-leading ROI for our clients and partners,” added Verstraete.

Teladoc, Inc. (NYSE:TDOC) is the nation’s leading provider of telehealth services and a pioneering force in bringing the virtual care visit into the mainstream of today’s health care ecosystem. Serving some 7,000 clients — including health plans, health systems, employers and other organizations — more than 17 million members can use phone, mobile devices and secure online video to connect within minutes to Teladoc’s network of more than 3,100 board-certified, state-licensed physicians and behavioral health specialists, 24/7. With national coverage, a robust, scalable platform and a Lewisville, TX-based member services center staffed by 400 employees, Teladoc offers the industry’s most comprehensive and complete telehealth solution including primary care, behavioral health care, dermatology, tobacco cessation and more. For additional information, please visit www.teladoc.com.

Aprima survey also reveals physicians and administrators predict changes to Obamacare but no repeal; and a reduction in regulatory burdens for providers

Dallas, TX (December 6, 2016) – Aprima Medical Software, a leading provider of innovative electronic health records (EHR), practice management (PM) and revenue cycle management solutions (RCM) for medical practices, today announced the results of a post-presidential election survey of healthcare professionals, which explored predictions for healthcare under a Trump administration. The majority of the 312 physicians and practice staff participating in the survey (52%) believe a Trump presidency will improve healthcare in the U.S, while 48% anticipate a positive financial impact on their practice.

The majority of healthcare professionals (62%) also expect changes to some aspects of the Affordable Care Act, though less than one-third expect a total repeal. Fifty-nine percent are optimistic that physician practices will experience a decrease in regulatory burdens, though respondents were divided in terms of the potential impact on provider compensation models and on patient access to care.

“This presidential election cycle was one of the most unpredictable in recent history and we were curious to understand what customers and prospects believe the impact will be on our industry,” said Michael Nissenbaum, CEO and president of Aprima. “I think it’s particularly notable that the majority of the survey participants expect a Trump administration to be better for healthcare than what we’ve experienced under the Obama administration, though 30% predict it will be worse. Healthcare providers, like the rest of the country, appear cautiously optimistic, though not overwhelmingly convinced that we’ll see positive changes under the new administration.”

The survey, which was emailed to almost 19,000 healthcare professionals following the November 8 election, allowed participants to clarify why they believed healthcare would be better or worse under a Trump administration. Many expressed predictions that certain aspects of Obamacare will be repealed and replaced with programs that include fewer regulatory burdens on providers and lower premiums for consumers. Other healthcare professionals voiced concerns that the number of uninsured patients will increase and create additional burdens on the industry.

“The survey results reflect some uncertainty about how provider compensation will be impacted,” said Nissenbaum. “In recent years, we have seen a shift from fee-for-service compensation models to plans that reward providers for cost-effective care and quality-outcomes. Though 38% of the healthcare professionals predict we’ll continue in this direction, 40% believe we’ll see a shift back to fee-for-service. Participants were also evenly split in terms of how patient access to care will be affected, with 36% anticipating access becoming more difficult and 36% predicting no significant impact to accessibility.”

Of those responding to the survey, 89% were affiliated with independent physician offices and included both Aprima customers and non-customers. Physicians and other clinical professionals represented 52% of the participants, while 48% were administrative staff members.

About Aprima Medical Software, Inc.

Aprima provides innovative electronic health record, practice management and revenue cycle management solutions for medical practices. Throughout the company’s 18-year history, Aprima has delivered quality solutions that have helped thousands of users enhance patient care and satisfaction, as well as improve their practices’ bottom lines. The Aprima EHR/PM sets the benchmark for ease-of-use, speed, and flexibility, thanks to its single database and customizable design that adapts automatically to individual physician workflows. The Aprima solution has earned Certification for Meaningful Use Stage 2 and been awarded pre-validation status for NCQA PCMH recognition. The company is based in Richardson, Texas and performs all development, support and implementation from within the U.S. To learn more about how Aprima can help your practice, please visit www.aprima.com, call us at 844 4APRIMA or email us at info@aprima.com.

The Sutter Health network is launching a new research project which will blend patient-reported and EHR-based data to improve the precision of multiple sclerosis treatment. Sutter will fund the project with a $1.2 million award from the California Initiative to Advance Precision Medicine.

To conduct the project, Sutter Health researchers are partnering with colleagues at the University of California, San Francisco. Working together, the team is developing a neurology application dubbed MS-SHARE which will be used by patients and doctors during appointments, and by patients between appointments.

During the 18-month demonstration project, the team will build the app with input from the health system’s doctors as well as MS patients. Throughout the process of care, the app will organize both patient-reported data and EHR data, in a manner intended to let doctors and patients view the data together and work together on care planning.

Over the short term, researchers and developers are focusing on outcomes like patient and doctor use of the app and enhancing the patient experience. Its big picture goals, meanwhile, include the ability to improve patient outcomes, such as disease progression and symptom control. Ultimately, the team hopes the results of this project go beyond supporting multiple sclerosis patients to helping to improve care for other neurological diseases such as Parkinson’s Disease, seizure disorders and migraine headaches.

The Sacramento, Calif.-based health network pitches the project as potentially transformative. “MS-SHARE has the potential to change how doctors and patients spend their time during appointments,” the press release asserts. “Instead of ‘data finding and gathering,’ doctors and patients can devote more time to conversation about how the care is working and how it needs to be changed to meet patient needs.”

Time for an editorial aside here. As a patient with a neurological disorder (Parkinson’s), I’m here to say that while this sounds like an excellent start at collaborating with patients, at first glance it may be doomed to limited success at best.

What I mean is as follows. When I meet with the neurologist to discuss progression of my symptoms, he or she typically does little beyond the standard exam. In fact, my sense is that most seem quite satisfied that they know enough about my status to make decisions after doing that exam. In most cases, little or nothing about my functioning outside the office makes it into the chart.

What I’m trying to say here is that based on my experience, it will take more than a handy-dandy app to win neurologists over to collaborating over charts and data with any patient. (Honestly, I think that’s true of many doctors outside this specialty, too.) And I’m not suggesting that this is because they’re arrogant, although they may be in some cases. Rather, I’m suggesting that it’s a workflow issue. Integrating patients in the discussion isn’t just a change of pace, it could be seen as a distraction that could lead to worse care rather than better. It will be interesting to see if that’s how things turn out.

One of the most interesting things I saw at RSNA 2016 in Chicago this week was Philips’ Illumeo. Beside being a really slick radiology interface that they’ve been doing forever, they created a kind of “war room” like dashboard for the patient that included a bunch of data that is brought in from the EHR using FHIR.

When I talked with Yair Briman, General Manager for Healthcare Informatics Solutions and Services at Philips, he talked about the various algorithms and machine learning that goes into the interface that a radiologist sees in Illumeo. As has become an issue in much of healthcare IT, the amount of health data that’s available for a patient is overwhelming. In Illumeo, Philips is working to only present the information that’s needed for the patient at the time that it’s needed.

For example, if I’m working on a head injury, do I want to see the old X-ray from a knee issue you had 20 years ago? Probably not, so that information can be hidden. I may be interested in the problem list from the EHR, but do I really need to know about a cold that happened 10 years ago? Probably not. Notice the probably. The radiologist can still drill down into that other medical history if they want, but this type of smart interface that understands context and hides irrelevant info is something we’re seeing across all of healthcare IT. It’s great to see Philips working on it for radiologists.

While creating a relevant, adaptive interface for radiologists is great, I was fascinated by Philips work pulling in EHR data for the radiologist to see in their native interface. Far too often we only talk about the exchange happening in the other direction. It’s great to see third party applications utilizing data from the EHR.

In my discussion with Yair Briman, he pointed out some interesting data. He commented that Philips manages 135 billion images. For those keeping track at home, that amounts to more than 25 petabytes of data. I don’t think most reading this understand how large a petabyte of data really is. Check out this article to get an idea. Long story short: that’s a lot of data.

How much data is in every EHR? Maybe one petabyte? This is just a guess, but it’s significantly smaller than imaging since most EHR data is text. Ok, so the EHR data is probably 100 terabytes of text and 900 terabytes of scanned faxes. (Sorry, I couldn’t help but take a swipe at faxes) Regardless, this pales in comparison to the size of radiology data. With this difference in mind, should we stop thinking about trying to pull the radiology data into the EHR and start spending more time on how to pull the EHR data into a PACS viewer?

What was also great about the Philips product I saw was that it had a really slick browser based HTML 5 viewer for radiology images. Certainly this is a great way to send radiology images to a referring physician, but it also pointed to the opportunity to link all of these radiology images from the EHR. The reality is that most doctors don’t need all the radiology images in the EHR. However, if they had an easy link to access the radiology images in a browser when they did need it, that would be a powerful thing. In fact, I think many of the advanced EHR implementations have or are working on this type of integration.

Of course, we shouldn’t just stop with physicians. How about linking all your radiology images from the patient portal as well? It’s nice when they hand you a DVD of your radiology images. It would be much nicer to be able to easily access them anytime and from anywhere through the patient portal. The great part is, the technology to make this happen is there. Now we just need to implement it and open the kimono to patients.

All in all, I love that Philips is bringing the EHR data to the radiologists. That context can really improve healthcare. I also love that they’re working to make the interface smarter by removing data that’s irrelevant to the specific context being worked on. I also can’t wait until they make all of this imaging data available to patients.